Getting Close on Health Care

It is difficult for anyone schooled in the Catholic Church’s social justice tradition not to be moved, and moved profoundly, by the prospect of near universal health insurance, a prospect that took a giant step towards realization early this morning when the Senate invoked cloture on the reform legislation. Yet, the USCCB has said the bill should not move forward in its current form mainly because the provisions regarding the coverage of abortion are insufficient. Are the bishops right?

The short answer is: Yes. But, the more complicated answer is: It depends. The difference between the short and the complicated answer is reflected in the statements the bishops have been issuing. In contrast to some of the snarky attacks on Sen. Bob Casey and Sen. Ben Nelson coming from some pro-life leaders, the bishops applauded Casey’s "good-faith effort" to forge an acceptable compromise and noted that the final changes Nelson negotiated entailed further improvements of the underlying bill. And, the bishops acknowledged that they are still studying the changes.

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To be clear, I wish profoundly the Senate had adopted the Stupak Amendment. And, the bishops wish the same thing. But the Stupak language was voted down in the Senate on a vote of 54-45. So, Lesson #1 from this whole affair is that we need more pro-life Senators. But, the response to the defeat of Stupak in the Senate cannot be to throw up our hands and the changes wrought, first by Casey and then by Nelson are not insignificant.

Lesson #2 is that we need more progressive Senators. If the Senate leadership had not had to cave previously on the public option, and if they had not had to cave on the Medicare buy-in, it would have been easier for Nelson to dig in and insist on the Stupak language. After those prior concessions to moderate sensibilities, if the Senate leadership had signed on to the Stupak language, several progressive senators would have bolted. Again, the difference between the USCCB which has stuck to its pro-health care reform stance provided there is no federal funding of abortion and some conservative outfits that have made it clear they just want to torpedo health care reform is a stark moral difference.

No one has been able to explain to me exactly how one provision of the final amendments will work. Women who are getting coverage through the exchanges with a federal subsidy will have to write two checks to the insurance company every month, one for their basic coverage and one for their abortion coverage. This would appear to achieve something that Stupak hinted at but did not enact, namely, riders. And, this is the reason that Planned Parenthood and NARAL have announced their objections to the bill. I am not a lawyer nor an expert on health insurance, so I am waiting for confirmation from others with greater expertise, but it seems to me that in this regard, the Nelson compromise is actually better, much better, than the Stupak language. Under this new compromise, every month, when she writes her premium check, a woman would be reminded: Abortion is not like other health care, which is the philosophic and moral heart of the Hyde Amendment.

On short, even if the USCCB in the end feels that the Stupak language is preferable to the Nelson language, the question is whether or not the Nelson language is close enough to Stupak to warrant, if not support, at least a willingness not to demonize those who support the bill. The most recent statement from the conference is certainly less strident than what one finds coming for the American Life League or the NRLC. That lack of stridency is increasingly appropriate as the Senate bill looks more and more like the House bill.

 

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Think Catholic
7 years 12 months ago
"Women who are getting coverage through the exchanges with a federal subsidy will have to write two checks to the insurance company every month, one for their basic coverage and one for their abortion coverage."
 
Mr. Winters, do you perhaps understate the case?  Not just women, but all insured by a plan covering abortion must-are required by federal law under this plan-to pay at least $12 each month for abortions even if they don't want abortion coverage.  That's an abortion tax by our federal governement, for the first time ever.  And these plans are federally-funded, so they are not like separate riders as you suggest.  There is still an identical problem of insignificant accounting "declarations" that the federal money is not funding abortion.
 
We need more pro-life senators?  Please explain why you opposed so many of them last year simply because they had Rs next to their names.  And we need more progressive senators?  They are the same people who would vote against the plan if Stupak's language was accepted.  There is a fundamental inconsistency with your claim to support pro-life policy and your support for the most strident advocates of pro-abortion policy out there.
 
Finally, you are fully in your right to call for more civility. But there's a difference between civility and complacency.  The USCCB balances its civility with a heightened sense of urgency and call to action to STOP THIS ABORTION INCREASE NOW.  There's only one chance left to stop it, and that's for the Stupak coalition to hold in the House.  If your "civility" (which you don't apply towwards pro-lifers) is not balanced with an urgent, unequivocal call for decisive action to stop the plan, then you're really just signaling that you are fine with the abortion increase (while wishing to claim you opposed it). 
John Hayes
7 years 12 months ago
I regret losing the public option but the result was that the abortion provisions now only have to deal with the simpler issue of subsidized private plans. I've studied Section 1303 of the current bill and I think it makes clear that public money is not being used to subsidize abortions (other than those allowed by Stupak and Hyde - rape, incest, life of the mother).
The main loss compared to Stupak is that the definition of which abortions are allowed to be funded with public money is linked to Hyde rather than being restated in this bill - so if any future changes are made in the annual re-enactment of Hyde, they would also apply here. 
It's a prudential decision, but I would not risk losing the chance to provide health coverage for millions of currently uninsured people by voting against this bill - rather than letting it go to conference for reconciliation with the House version.   
 
 
John Hayes
7 years 12 months ago
"all insured by a plan covering abortion must-are required by federal law under this plan-to pay at least $12 each month for abortions even if they don't want abortion coverage."
Factually, the figure is $1 per month. The bill says the insurer "may not estimate such a cost at less than $1 per enrollee, per month."
But apart from the amount, why would anyone buy a policy that includes abortion services and not expect that part of their payment would be used to pay for abortions? The requirement to pay that amount separately has the good effect of making that more apparent to the buyer.
The way to avoid that is to buy a policy that doesn't include abortion services. 
Michael Liddy
7 years 12 months ago
When Hyde is not included in a DHHS annual budget bill, then we will all pay for Medicaid abortions and we will all pay for all abortions for the tens of millions of Americans who get their insurance through these new insurance exchanges - the legislation is set up to have this dominoe effect. If you need any proof that Hyde will be removed, just take a look at the manager's amendment which removes the current abortion funding restrictions in the Indian Services Budget Bill or the Washington DC Funding Bill, which President Obama recently signed, that removed the abortion funding restrictions for DC. Stupak is permanent block because it codifies the Hyde Language in the health care bill itself. That is the type of language you need - Nelsen's amendment is paper thin.
Tony Annett
7 years 12 months ago
A number of issues:
First, we need to get away from the claim that the government is “funding abortion”. People buy health care plans that may or may not cover abortion, and – if their income is low enough – they get subsidies. The private sector is funding abortion - every single one of these plans will be private. Sure, there will be subsidies, but this argument is not that helpful. After all, one can stretch this to argue that a person who receives any transfer from the government, such as unemplyment benefit, may turn around and procure an abortion with these funds.
The second issue is turning the decision over to the states. Here, I detect some clear irony, for "returning the issue to the states" is the clear rallying cry of those who deem the overturn of Roe as the principal pro-life tactic. Even abp Chaput has made this argument (see here: http://vox-nova.com/2009/12/19/nelson-compromise-sell-out-or-stroke-of-genius/)
Think about it this way. For the first time ever, the scandalous relationship between the private inusrance companies and the abortion industry is on the public radar. Without this bill, this would not have happened. Without this bill, the RNC's healthcare plan would still be offering insurance. For is there any real moral difference between paying out of your pocket for a private insurance plan, or paying indirectly through your taxes, when - in each case - the money is going to an insurance company that somewhere is funding some abortion? For the first time, we are getting some restrictions at the federal level of the funding of abortion by private insurance - who would have thought it? Certainly, the NRLC never cared about this.
Think Catholic
7 years 12 months ago
Minion can always be counted on to defend any expansion of abortion when it comes from his own party.  Send it to the states?  That's nice when the federal policy is worse than the state policy, but no Catholic pro-lifer proposes sending an issue to the states where federal policy on the unborn is better.  So we have federal policy that protects the unborn, and Minion thinks his abortion-expansive policy is justified by sending it to the states.  Except that it isn't really about sending it to the states.  Because that implies the federal government is neutral.  But it isn't-makes the federal government choose sides, the abortion side, by federally funding abortion insurance, and starting with a default that every state is IN, and oh yes if they can to get both branches of state congress plus the executive to get OUT, then maybe they'll be out, though the federal government will still be in, and therefore the entire healthcare industry will feel the weight of the federal government behind abortion as healthcare.  We will go from 33 states where real pro-lifers have slaved to pass laws against abortion coverage (getting only vitriol from Minion as thanks) to 0 states, overnight.  So send it to the states with the dice loaded in favor of a heavy pro-abortion default is what Minion thinks is the pro-life position.  But he thinks anything justifying whatever the Democrats are doing is a pro-life position, so no shock there.
 
John if employers choose an abortion plan employees must pay the abortion tax-they have no right to opt out.  The federal government is putting its massive thumb on the pro-abortion side of the scale.
Think Catholic
7 years 12 months ago
Minion you say you want to take a stand against nihilism.  The problem is you don't care what stand you take as long as it's against what you view as nihilism.  You're quite content to take a stand for pro-baby-killing policy, as long as it's against your enemy who bears your label of nihilism.  And you tell everyone it's Catholic kinda thing to do, because that will get people to forget you are taking a stand for pro-baby-killing policy.
7 years 12 months ago
Maybe we don't need more progressive politicians. Maybe what we need is more politicians who are something more than Catholic " in name only ". Maybe we need Catholic politicians who are faithful to the teachings of the Church. Maybe we need to introduce them to the concept of shame.
7 years 12 months ago
''Again, the difference between the USCCB which has stuck to its pro-health care reform stance provided there is no federal funding of abortion and some conservative outfits that have made it clear they just want to torpedo health care reform is a stark moral difference.''
I think this somewhat misrepresents the moral intentions & analysis of conservatives opposed to the Democratic health reform package.  I have not heard or read a single responsible conservative opponent who disagrees as a matter of morality that health care can & should be reformed, or that we should expand health coverage to those who want yet cannot afford to procure such coverage for themselves (as opposed to mandating that otherwise healthy individuals who choose to forego health insurance procure such).  Rather, what conservatives object to is the means by which this goal is being obtained - massive expansion of unfunded liabilities & the creation of a large new government program.  Conservatives would prefer smaller, targeted reforms at items like tort reform, inter-state competition, result-driven treatment and other market-driven reforms that aim to remove the expense from health costs & thereby make it easier to obtain health insurance.  But whether one prefers the liberal or conservative approach, I don't think your characterization of their moral intent is accurate.
Tony Annett
7 years 12 months ago
"Conservatives would prefer smaller, targeted reforms at items like tort reform, inter-state competition, result-driven treatment and other market-driven reforms that aim to remove the expense from health costs & thereby make it easier to obtain health insurance."
Except that none of their proposals will do any of this. In case you have not noticed, the delivery-system reforms in this bill will go a long toward reducing costs in healthcare provision (bundled payments, prudent purchasing, the excise tax on high-value health insurance, comparative effectiveness review, better health information technology, and the individual mandate). And yet, if the GOP has been really serious about joining this debate, they could have gotten more cost control measures, and possibly tort reform (this measure doesn't do much for costs, but it doesn't hurt either).
Oh, and they could have gotten more ironclad abortion protections, too.
The inter-state competition thing is a non-starter. Absent strong regulations, it would simply lead to a race to the bottom, with every insurance company locating in the state with the fewest regulations.
But the GOP did produce their own plan. It's horrible. It leaves 52 million uninsured, and at the same time letting insurance companies continue to penalize people (refuse or drop coverage, charge exorbitant premiums) for pre-existing conditions. In top of everything, it reduces the deficit by less than any Democratic plan.
But what do facts and policy analysis matter when we have slogans? That is the whole problem. They can't win on facts and policies, and they don't want to. It's time to take a stand against nihilism.
John Hayes
7 years 12 months ago
John if employers choose an abortion plan employees must pay the abortion tax-they have no right to opt out.  The federal government is putting its massive thumb on the pro-abortion side of the scale.
-Matt
Sec. 1312(a)92)(B) of the bill provides that, even if an employer is subsidizing the premiums of a plan bought through an exchange, the employee gets to choose the plan. The employer can only specify the cost level of the plan (bronze, silver, gold, platinum).
It's better than the current private-sector situation in which an employer could offer only plans which cover abortion expenses. I'm not aware of any position of the Bishops that Catholics should refuse to join those plans. 
 
7 years 12 months ago
"In case you have not noticed, the delivery-system reforms in this bill will go a long toward reducing costs in healthcare provision". I think the CBO begs to differ with you.
 
You basically blame the Republicans for not getting what they wanted in the bill, i.e the abortion provisions.  How do you presume that they do that when the Senate couldn't even pass the Stupak Amendment?
Finally, you say inter-state competition would be a race to the bottom.  The issue isn't the location of the company, but rather giving consumers the power to choose among plans, rather than the current (highly regulated & therefore highly expensive) alternative.  A race to the bottom wouldn't be a bad thing at all.
 
Think Catholic
7 years 12 months ago
John says "I'm not aware of any position of the Bishops that Catholics should refuse to join those plans."  To find out what the bishops think of this plan just look at http://www.usccb.org/comm/archives/2009/09-264.shtml : "It does not seem to allow purchasers who exercise freedom of choice or of conscience to "opt out" of abortion coverage in federally subsidized health plans that include such coverage. Instead it will require purchasers of such plans to pay a distinct fee or surcharge which is extracted solely to help pay for other people's abortions."  That's signed by Bishop William Murphy who chairs the bishops’ Committee on Domestic Justice and Human Development. and Bishop John Wester who chairs the bishops’ Committee on Migration.  Are they Republican shills?  Only in the eyes of a Democrats-are-aleays-right-even-when-promoting-abortion partisan.
 
Putting the federal government's weight behind making abortion standard health care is a massive expansion of the abortion industry.  It's not "better."
Jeff Bagnell
7 years 12 months ago
These people are going to get their rear ends handed to them in 2010.  Impose that $12 abortion tax on Americans and see what happens, Congress.  
John Hayes
7 years 12 months ago
Matt quotes the three bishops' December 19 statement (which I have read):
"It does not seem to allow purchasers who exercise freedom of choice or of conscience to "opt out" of abortion coverage in federally subsidized health plans that include such coverage."
That's correct, but is it a deal-breaker if you have the choice of buying a plan that doesn't include abortion coverage? Why insist you want the plan that includes abortion coverage but without that coverage?
My comment was simply that I have never heard a statement that Catholics should not buy a health insurance policy that is otherwise desirable but happens to include abortion services - if that was not their reason for buying it. I am sure people have different opinions on that, but I am not aware of any official church position to date.     
Burke Balch
7 years 12 months ago
Visitors to this blog will, I hope, check out my 4-part response on the earlier blog of comments on ''Kudos to Casey, Bronx Cheer for NRLC'' to the criticism by Morning Minion and others of the National Right to Life Committee's position on denial of lifesaving medical treatment, or rationing.  That is accessible at http://www.americamagazine.org/blog/entry.cfm?blog_id=2&id=93194748-3048-741E-7095779216260113&comment=1&success=1
Burke J. Balch, J.D., Director, Robert Powell Center for Medical Ethics
National Right to Life Committee
James Lindsay
7 years 12 months ago
I have a feeling that Stupak (which goes beyond Hyde) was meant to be a poison pill in the Senate.  I think the NRLC, which is aligned with the Republican Party. is so opposed to the Nelson language because it moves the bill to conference.  Once Stupak and Nelson strike a deal, the bill passes without abortion as an axcuse.  As I have been saying all along, this bill is good for the unborn, since families which don't need to worry about health care are more likely to keep growing and not resort to abortion.

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